Provider Demographics
NPI:1861978926
Name:PHAM, ELLEN PHUONG-HOA (BSN, RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:PHUONG-HOA
Last Name:PHAM
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 PARLIAMENT PL STE F
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1843
Mailing Address - Country:US
Mailing Address - Phone:301-459-9117
Mailing Address - Fax:301-459-1478
Practice Address - Street 1:4451 PARLIAMENT PL STE F
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1843
Practice Address - Country:US
Practice Address - Phone:301-459-9117
Practice Address - Fax:301-459-1478
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224510163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse